Special Enrollment Rights with Loss of Coverage in Medicare Advantage Plan

[waid10]

We have several employees who are 65+ that dropped our employer-sponsored health plan and enrolled in a Medicare Advantage Plan operated through an entity that provides Medicare Advantage plans. This entity is about to announce that they are no longer going to offer this plan and it will end sometime in the next few months (well before the Medicare enrollment period.) My question is, would losing their Medicare Advantage plan be a qualified life event that triggers special enrollment rights to allow them to enroll in our employer-sponsored health plan?

Thanks.

[QDROphile]

Are you asking if the employee has a right to enroll in the plan, or if section 125 and the terms of the cafeteria plan allow the employee to change the salary reduction amount mid-year for payment of the employee portion of the premium. The cafeteria plan can be more restrictive about mid-year changes than the law, but most are not, so checking plan terms might answer that question.

[waid10]

The employee had previously dropped the employer-sponsored plan to enroll in the Medicare Advantage Plan. Does that drop bar the employee from coming back to the employer plan except for during a regular open enrollment period? I am asking if the loss in coverage in the Medicare Advantage Plan allows the employee to enroll in the employer-sponsored plan.

[Flyboyjohn]

The answer depends on the terms of your employer-sponsored group health plan.

I'll bet you don't have a health plan document so the closest substitute will be the

contract with your health insurer, check to see if it limits mid-year enrollments to

"special enrollment periods" and if so they should be well defined.

Of course, as QDROphile mentioned, if the newly enrolling employee wants to have their

portion of the premium deducted from their pay pre-tax they have to meet the "change in family status" rules found in your cafeteria plan document.

[GMK]

The third topic here:

https://www.medicare.gov/sign-up-change-plans/when-can-i-join-a-health-or-drug-plan/special-circumstances/join-plan-special-circumstances.html#collapse-3206

says:

I have a chance to enroll in other coverage offered by my employer.

What can I do?

Drop your current Medicare Advantage Plan or Medicare Prescription Drug Plan to enroll in the private plan offered by your employer or union.

When?

Whenever your employer or union allows you to make changes in your plan

So, it looks as if you can do it mid-term if your employer's plan allows for the special enrollment period.